Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Orthopaedics PPT 3 Prosthesis After Amputations Lecture Notes
Prosthesis after Amputations
Learning objectives
? Post operative and preprosthetic care
? Overview of prosthesis available for amputees
? Basics of evaluation of patients
? Prosthetic prescription
Postoperative and Preprosthetic Care
Individuals with New Amputation
? Likely to experience acute surgical pain
? Grieving the loss of his or her limb- requires significant psychological
adjustment.
Early Goals
? Healing of suture line and overall health
status.
? Enhancing early single limb mobility and self
-care
? Control of edema and pain management
? Optimal shaping of the residual limb for
prosthetic wear
? Assessment of the potential for prosthesis
Assessing Residual Limb Length and Volume
? Important determinants of readiness for prosthetic use, as well as
socket design
? Stump length needs to be documented
? Limb volume and shape of a transtibial residual limb is assessed
by taking successive circumferential measures
REHABILITATION
? Prosthesis
? Conventional- Cheaper to produce but are heavy.
? Endolite - composite carbon fiber is used.
? Has to be custom made and tailored to be useful to the patient.
? A large number of patients do not use their prosthesis if it is
cumbersome or heavy
Immediate postoperative prosthesis
The socket
? Interface between the residual limb and
the prosthesis
? All the forces from the ground during gait
are transferred to the limb
? Forces from the limb needed to control
the motion of the prosthesis are
transferred to the prosthesis
Extra component that is mounted directly
under the socket to reduce amount of torque
and shock
socket and pylon are concealed to within a
cosmetic cover.
Potential of Use
Level K 0
? No potential to ambulate or transfer safely with assistance .
Level K1
? Potential to use a prosthesis for ambulation on level surfaces at fixed
cadence.
? Limited and unlimited household ambulator.
K1- Solid-ankle, cushion-heel (SACH) foot
? Most basic prosthetic foot available.
? Immovable ankle and soft heel give
it the ability to absorb the impact of
heel strike
? Provides minimal energy return.
? For limited functional ability and
potential to ambulate.
Level K 2
? Potential for ambulation with the ability to traverse low-level
environmental barriers such as curbs, stairs or uneven surfaces.
? Typical of the limited community ambulator
? lightweight, have a flexible keel, a multiaxial ankle, and provide some
energy return
Level K 3
? Potential for ambulation with variable cadence.
? Ability to traverse most environmental barriers
? Have vocational, therapeutic, or exercise activity beyond simple
locomotion
? Hydraulic ankle/Microprocessor
Level K 4
? Potential for prosthetic ambulation
that exceeds basic ambulation skills,
exhibiting high impact, stress, or
energy levels.
? Typical of the child, active adult, or
athlete.
Selection of Foot- Importance?
? Ground reaction forces are transmitted
? Can be damaging to the person's residual limb, knee, hip, or back.
? Proper prosthesis - expand their capabilities and motivation
dramatically and allows them to improve range of activities
? At least design for one level above
A J- 20 years old
? A soldier, was when he endured traumatic injuries after driving
his motor vehicle over a landmine
? Below knee amputee
? Determined to run again and plans to enrol at a local college
Which foot does he require?
? K1
? K2
? K3
? K4
Answer ? K3 for daily use and K4 for running
Jaipur foot BK Prosthesis
? The shank is fabricated from locally
manufactured, durable, high-quality, high-
density polyethylene pipes (HDPE).
? The socket design used is either total
contact, which is vacuum-formed using a
polypropylene sheet, or open-ended, using
HDPE.
? This custom-made shank / socket is fitted
with the Jaipur Foot.
? Dorsi-flexion,
? Inversion / Eversion
? Transverse rotation
? Enables amputees to walk,
run, trek, swim, squat, sit cross
legged,
? walk on uneven terrain, work in
wet muddy fields
AMPUTATIONS OF THE HIP AND PELVIS
?Through the femur from
5cm distal to the lesser
trochanter .
?Disarticulations of the hip.
?Hindquarter amputations.
AMPUTATIONS OF THE UPPER LIMB
? Hand
? Preserve as much function as is possible.
? Salvage procedure
? Preserve length
? Mobility and sensibility
? Functions of pinch and grasp are very important.
AMPUTATIONS OF THE UPPER LIMB
? Wrist Disarticulations- Separate the carpal bones from the radius
? Forearm amputations- substance of the radius and ulna
? Elbow disarticulations- Humerus is preserved
? Arm amputations- 30% of humeral length
? Disarticulation of shoulder- less than 30% of humerus
? forequarter amputation- Shoulder and scapula
AMPUTATIONS OF THE UPPER LIMB
? Wrist amputations-preserve supination and pronation may be
transcarpal or disarticulation through wrist.
? Transcarpal ? Flexion and extension of radiocarpal joints should be
preserved
? Can be fitted with thin prosthetic wrist units.
? Long lever arm increases the ease and power to use the prosthesis.
FOREARM AMPUTATIONS
? Preserve as much length as possible.
? A smal stump is preferable to a through elbow
? Can be fitted with a good prosthesis.
DISARTICULATION ELBOW
? Broad flair can be firmly grasped by the prosthesis
socket
? Humeral rotation can be transmitted to the
prosthesis.
? Preferable to a more proximal amputation
ARM AMPUTATIONS
? Trans condylar after prosthetic fitting function as elbow
disarticulations
? Proximal level amputations require and inside elbow lock
mechanism and an elbow turntable
? Preserving the proximal humerus is valuable-cosmetical y the
contour of the shoulder is preserved and the grip of the socket is
better .
SHOULDER AMPUTATIONS
? Surgical neck
? Disarticulation of the shoulder
? Forequarter amputation
? With prosthesis function is so severely impaired that the prosthesis
can only be used as a holding device when performing activities
with both hands.
Conventional (body-powered)
transhumeral prosthesis
Terminal Devices
PROSTHETIC PRESCRIPTION
? socket design
? skin-socket interface
? suspension strategy
? Additional modular components
SUMMARY
? Prosthetic rehabilitation of persons with amputations is both
challenging and rewarding.
? Success is often difficult to measure purely in clinical terms
? Maximizing individual functional potential
? Appropriate amount of technology to assure acceptable outcomes
are highly predictive of success.
This post was last modified on 07 April 2022